R04.0 ICD-10-CM Code: Epistaxis

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R04.0 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Coder workflow for R04.0

MedCoder structured workflow — derived from this code’s own official record

Before you code R04.0

1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

   Guide: Symptom code vs confirmed diagnosis →

Choose the right path

1. Is an established diagnosis that explains this sign or symptom documented?
   Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
   No → Continue — the sign or symptom code stands when no definitive diagnosis is established.

Consider R04.0. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (6)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Bleeding, nose
• Epistaxis (multiple)
• Hemorrhage, hemorrhagic (concealed), nasal turbinate
• Hemorrhage, hemorrhagic (concealed), nose
• Hemorrhage, hemorrhagic (concealed), postnasal
• Nosebleed

Don’t confuse R04.0 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of R04.0 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• R04.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Hemorrhage from respiratory passages, unspecified” takes R04.9; specificity in the record moves it back here.

  Full comparison: R04.0 vs R04.9 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 150 (MDC 03), DRG 151 (MDC 03).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM013 — Respiratory signs and symptoms (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Respiratory signs and symptoms).

R04.1 — Hemorrhage from throat, R04.2 — Hemoptysis, R04.81 — Acute idiopathic pulmonary hemorrhage in infants, R04.89 — Hemorrhage from other sites in respiratory passages, R04.9 — Hemorrhage from respiratory passages, unspecified, R05 — Cough, R05.1 — Acute cough, R05.2 — Subacute cough, R05.3 — Chronic cough, R05.4 — Cough syncope, R05.8 — Other specified cough, R05.9 — Cough, unspecified, R06.00 — Dyspnea, unspecified, R06.01 — Orthopnea, R06.02 — Shortness of breath, R06.03 — Acute respiratory distress, R06.09 — Other forms of dyspnea, R06.1 — Stridor, R06.2 — Wheezing, R06.3 — Periodic breathing, +20 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Hemorrhage, hemorrhagic”, “Bleeding”; these codes share that main term but sit in a different category of the Tabular List.

P52.8 — Other intracranial (nontraumatic) hemorrhages of newborn (extradural, newborn), P52.9 — Intracranial (nontraumatic) hemorrhage of newborn, unspecified (intracranial, newborn), P53 — Hemorrhagic disease of newborn (disease, newborn), P54.2 — Neonatal rectal hemorrhage (rectum, rectal, newborn), P54.3 — Other neonatal gastrointestinal hemorrhage (bowel, newborn), P54.4 — Neonatal adrenal hemorrhage (adrenal, newborn), P54.5 — Neonatal cutaneous hemorrhage (skin, newborn), P54.6 — Neonatal vaginal hemorrhage (vagina, vaginal, newborn), P54.8 — Other specified neonatal hemorrhages (nose, newborn), P54.9 — Neonatal hemorrhage, unspecified (newborn), R23.3 — Spontaneous ecchymoses (skin), R31.9 — Hematuria, unspecified (genitourinary NOS), R58 — Hemorrhage, not elsewhere classified, S06.37 — Contusion, laceration, and hemorrhage of cerebellum (cerebellar, cerebellum, traumatic), S06.38 — Contusion, laceration, and hemorrhage of brainstem (brainstem, traumatic), S06.6X — Traumatic subarachnoid hemorrhage (intracranial, subarachnoid, traumatic), T79.2 — Traumatic secondary and recurrent hemorrhage and seroma (secondary, following initial hemorrhage at time of injury), T82.837 — Hemorrhage due to cardiac prosthetic devices, implants and grafts (due to or associated with, device, implant or graft, heart NEC), T82.838 — Hemorrhage due to vascular prosthetic devices, implants and grafts (due to or associated with, device, implant or graft, vascular NEC), T83.83 — Hemorrhage due to genitourinary prosthetic devices, implants and grafts (due to or associated with, device, implant or graft, genital NEC), +155 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of R04.0 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

• R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R00-R09 — Symptoms and signs involving the circulatory and respiratory systems[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Clinical classification (CCSR)

• SYM013 — Respiratory signs and symptoms[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 150 — EPISTAXIS WITH MCC[MS-DRG]: “EPISTAXIS WITH MCC (MDC 03)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 151 — EPISTAXIS WITHOUT MCC[MS-DRG]: “EPISTAXIS WITHOUT MCC (MDC 03)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Bleeding, nose[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Epistaxis (multiple)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Hemorrhage, hemorrhagic (concealed), nasal turbinate[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Hemorrhage, hemorrhagic (concealed), nose[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Hemorrhage, hemorrhagic (concealed), postnasal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nosebleed[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• R04 — Hemorrhage from respiratory passages[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.1 — Hemorrhage from throat[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.2 — Hemoptysis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.8 — Hemorrhage from other sites in respiratory passages[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.81 — Acute idiopathic pulmonary hemorrhage in infants[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.89 — Hemorrhage from other sites in respiratory passages[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R04.9 — Hemorrhage from respiratory passages, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R04.0 in its code family, with their registry titles.

• R04 — Hemorrhage from respiratory passages
• R04.1 — Hemorrhage from throat
• R04.2 — Hemoptysis
• R04.8 — Hemorrhage from other sites in respiratory passages
• R04.81 — Acute idiopathic pulmonary hemorrhage in infants
• R04.89 — Hemorrhage from other sites in respiratory passages
• R04.9 — Hemorrhage from respiratory passages, unspecified

View all codes in the R04 family